As your child learns to use visuals for setting parameters,
gradually increase the length of time or the number of situations
in which your child is expected to wait for items or activities.
❏ What if challenging behaviors occur?
If you think that challenging behaviors may occur, introduce these
parameters during less difficult situations or begin with simple
expectations.
If problem behaviors occur, be consistent with the parameters
you have set. Focus on praising any aspects of the parameters
that are being followed, rather than shifting your focus to the
challenging behaviors.
Using visual supports can help you and your child with ASD
communicate and manage everyday activities in positive ways.
This publication was written by Whitney Loring, Psy.D., TRIAD
Postdoctoral Fellow, and Mary Hamilton, M.Ed., BCBA, TRIAD
Educational and Behavioral Consultant. This work was supported
through Beth Malow, M.D., M.S., Professor of Neurology, Principal
Investigator, Vanderbilt Autism Treatment Network Site, and Zachary
Warren, Ph.D., Assistant Professor of Pediatrics, Co-Principal
Investigator, Vanderbilt Autism Treatment Network Site. It was
edited, designed, and produced by the Dissemination and Graphics
staff of the Vanderbilt Kennedy Center for Excellence in Develop-
mental Disabilities. We are grateful for review and suggestions by
many, including by faculty of the Vanderbilt Kennedy Treatment and
Research Institute for Autism Spectrum Disorders (TRIAD) and by
the Autism Society of Middle Tennessee. This publication may be
distributed as is or, at no cost, may be individualized as an electronic
file for your production and dissemination, so that it includes your
organization and its most frequent referrals. For revision information,
please contact courtney.taylor@vanderbilt.edu, (615) 322-5658,
(866) 936-8852.
These materials are the product of on-going activities of the Autism
Speaks Autism Treatment Network, a funded program of Autism
Speaks. This publication was made possible, in part, by Grant no.
T73MC00050 from the Maternal and Child Health Bureau (MCHB),
Health Resources and Services Administration (HRSA), Department
of Health and Human Services (HHS). Its contents are solely the
responsibility of the authors and do not necessarily represent the
official views of the MCHB, HRSA, HHS. Printed March 2011.
Images ©2011 Jupiterimages Corporation.
Resources for Using Visual Supports:
❏ www.do2learn.com
❏ card.ufl.edu/content/visual.html
❏ www.kidaccess.com/index.html
❏ Eckenrode, L., Fennell, P., & Hearsey, K. (2004). Tasks Galore
for the Real World. Raleigh, NC: Tasks Galore.
Resources on Autism Spectrum Disorders:
❏ Treatment and Research Institute for Autism Spectrum
Disorders (TRIAD), Vanderbilt Kennedy Center, is dedicated to
improving assessment and treatment services for children with
autism spectrum disorders and their families, while advancing
knowledge and training. For information on TRIAD and Vanderbilt
autism services and resources:
Vanderbilt Autism Resource Line
Local (615) 322-7565
Toll free (1-877) ASD-VUMC [273-8862]
Email: autismresources@vanderbilt.edu
TRIAD Outreach and Training
(615) 936-1705
Web: triad.vanderbilt.edu
❏ Tennessee Disability Pathfinder, a free information and referral
service for all types of disabilities, all ages, provides information
on autism resources external to Vanderbilt. Local (615) 322-8529,
(1-800) 640-4636. Web: www.familypathfinder.org
❏ Local chapters of the Autism Society of America (ASA)
(www.autism-society.org) provide information, support, and
advocacy for individuals with ASD and their families.
Autism Society of Middle Tennessee
Phone: (615) 385-2077, (866) 508-4987
Email: asmt@tnautism.org
Web: www.tnautism.org
Autism Society of the Mid South
Phone: (901) 542-2767
Email: autismsocietymidsouth@yahoo.com
Web: www.autismsocietymidsouth.org
Autism Society of East Tennessee
Phone: (865) 247-5082
Email: asaetc@gmail.com
❏ Autism Speaks (www.autismspeaks.org/) provides resources and
support for individuals with ASD and their families.
Visual Supports and
Autism Spectrum Disorders
Introduction
FIRST
What are visual supports? A visual support Say “hi’
refers to using a picture or other visual item to
communicate with a child who has difficulty
understanding or using language. Visual supports
can be photographs, drawings, objects, written
words, or lists. Research has shown that visual
supports work well as a way to communicate.
Visual supports are used with children who have autism spectrum
disorders (ASD) for two main purposes. They help parents commu-
nicate better with their child, and they help their child communicate
better with others.
This brochure introduces parents, caregivers, and professionals
to visual supports and provides instruction on how to use them
effectively. Visual supports can be used with persons of any age,
although this brochure refers to children. Also, visual supports can
be used by caregivers other than parents.
Why are visual supports important? The main features of
ASD are challenges in interacting socially, using language, and
having limited interests or repetitive behaviors. Visual supports
help in all three areas.
First, children with ASD may not understand social cues as they
interact with others in daily activities. They may not grasp social
Get dressed Underwear Pants
Wait
THEN
Play with cars
expectations, like how to start a conversation, how to respond when
others make social approaches, or how to change behavior based
on unspoken social rules. Visual supports can help teach social
skills and help children with ASD use them on their own in social
situations.
Second, children with ASD often find it difficult to understand and
follow spoken instructions. They may not be able to express well what
they want or need. Visuals can help parents communicate what they
expect. This decreases frustration and may help decrease problem
behaviors that result from difficulty communicating. Visuals can
promote appropriate, positive ways to communicate.
Finally, some children with ASD are anxious or act out when their
routines change or they are in unfamiliar situations. Visuals can
help them understand what to expect and will happen next and also
reduce anxiety. Visuals can help them pay attention to important
details and help them cope with change.
Continued on next page
Shirt Socks Shoes

First – Then Board
❏ What is it?
A First-Then Board is a visual display of something your child
prefers that will happen after completing a task that is less
preferred.
FIRST THEN
Eat lunch Playground
❏ When is it helpful?
A First-Then Board is helpful in teaching children with ASD to
follow directions and learn new skills. A First-Then Board
motivates them to do activities that they do not like and clarifies
when they can do what they like. A First-Then Board lays the
language foundation needed to complete multi-step directions
and activities and to use more complex visual systems.
❏ How do I teach it and use it?
Decide what task you want your child to complete first (what goes
in the “first” box) and the preferred item or activity (what goes in
the “then” box) that your child can have immediately after the
“first” task is done. This preferred item/activity should be
motivating enough to increase the likelihood that your child will
follow your direction.
Put the visuals on the board (e.g., photos, drawings, written
words) that represent the activity you identified. Present the board
to the child with a brief, verbal instruction. Try to use the least
amount of words possible. For example, before beginning the
“first” task, say, “First, put on shoes, then swing.” If needed, refer
to the board while your child is doing the task. For example, say
“One more shoe, then swing” when your child is almost done.
When the “first” task is completed, refer back to the board.
For example, say “All done putting on shoes, now swing!” and
immediately provide the preferred, reinforcing item or activity.
In order to teach children with ASD the value of the First-Then
Board, you must give them the reinforcing activity or item after
they complete the “first” task. Otherwise, your child may not trust
the board the next time you use it.
❏ What if challenging behaviors occur?
If challenging behaviors occur, continue by physically prompting
your child to complete the “first” task. Keep your focus on the task
rather than on the challenging behavior. Then it is important to still
provide the reinforcing item or activity, since the focus of the board
is on completing the “first” task, and not on addressing challenging
behaviors.
If you think challenging behaviors may happen, begin by intro-
ducing the First-Then Board for a task that your child usually
completes willingly and successfully. If challenging behaviors
become more difficult to control, it may be appropriate to
consider behavioral consultation with a professional to address
these behaviors directly.
Visual Schedule
❏ What is it?
A visual schedule is a visual representation of what is going to
happen throughout the day or within a task or activity.
❏ When is it helpful?
A visual schedule is helpful for breaking down a task that
has multiple steps to ensure the teaching and compliance of
those steps. It is also helpful in decreasing anxiety and rigidity
surrounding transitions by communicating when certain
activities will occur throughout the day or part of the day.
❏ How do I teach it and use it?
After your child understands the concept of sequencing activities
through the use of a First-Then Board, you can develop a more
complex schedule for a series of activities during the day.
Decide the activities that you will picture in the schedule. Choose
activities that really will happen in that particular order. Try to mix
in preferred activities with non-preferred ones.
Put on the schedule the visuals (e.g., photos, drawings, written
words) that show the activities that you have identified. The
schedule can be portable, for example, on a binder or clipboard,
or it can be fixed to a permanent place, like a refrigerator or wall.
Your child should be able to see the schedule before beginning
the first activity on the schedule. It should continue to be visible to
your child during the rest of the activities.
When it is time for an activity on the schedule to occur, cue your
child with a brief, verbal instruction. For example, say “Check the
schedule.” This helps your child pay attention as the next activity
begins. At first, you may need to physically guide your child to
check the schedule (e.g., gently guide by shoulders and prompt
your child to point to the next activity on the schedule). You can
gradually decrease physical prompts as your child begins to use
the schedule more independently.
When a task is completed, cue your child to check the schedule
again, using the procedure described above, and transition to the
next activity.
Bathroom Brush teeth Bath Get dressed
Provide praise and/or other positive reinforcement to your child
for following the schedule and for transitioning to and completing
activities on the schedule. It may be helpful to use a timer that
your child can hear to make transition times clear to your child.
Mix variability into the schedule by introducing a symbol that
represents an unknown activity (e.g., “oops” or “surprise activity”).
Begin to teach this concept by pairing this with a positive activity
or surprise. Gradually use this for unexpected changes in the
schedule.
❏ What if challenging behaviors occur?
If challenging behaviors occur, continue by physically
prompting your child to complete the task that is occurring.
Keep your focus on the task rather than on the challenging
behavior. Then transition to the next activity as communicated
by the schedule and still provide the reinforcing item or
activities indicated on the schedule, since the focus of the
schedule is on completing the tasks, and not on addressing
challenging behaviors.
If you think challenging behaviors may happen, begin by intro-
ducing the visual schedule during tasks that your child usually
completes willingly and successfully. If challenging behaviors
become more difficult to control, it may be appropriate to
consider behavioral consultation with a professional to address
these behaviors directly.
Visually Setting Parameters
❏ What is it?
Setting parameters involves using visuals to set clear boundaries
around items or activities and to communicate basic expected
behaviors, like waiting.
❏ When is it helpful?
Visually setting parameters is helpful in communicating limits that
are part of an activity and that may seem unclear to your child.
Some examples of situations where this might be useful follow.
Communicate physical boundaries of an area or activity, for exam-
ple, use a “stop” sign to mark where to stop in the backyard. Or
show how much of an item or activity is available before it is gone.
For example, place a “not available” picture on the computer
when it is not time to play on the computer. Or place pictures of 3
juice boxes on the refrigerator and remove or cover one each time
Breakfast Backpack Bus
juice is given. Show the need to wait for something that is delayed
but will be available soon, for example, by providing a “wait” card
paired with a timer.
x x
Ice cream Ice cream Ice cream
❏ How do I teach it and use it?
Begin to teach the use of these visuals in situations that have
clear, defined, brief parameters. As your child understands these
visuals better, gradually increase their use in more long-term
activities and with more abstract parameters.
❏ Examples:
Physical boundaries: Place the visual on physical boundaries
that already are defined (e.g., a door) and refer to it when the rule
is followed. For example, when your child stops at the door, point
to the stop sign and say, “Stop.” Give praise or reinforcement for
complying with this parameter. After you have taught the concept,
use the same visual during other activities or in other settings
where the same boundary is needed but is not as clear, such as a
“Stop” sign on the playground.
Limited availability: Decide the number of times or length of
time that the item or activity is available. Indicate that through the
visual, for example, 3 pictures of a juice box on the refrigerator to
indicate that 3 juice boxes are allowed that day. After the item or
activity has been used or done, show the change by using the
visual, for example, cross out or remove one of the juice box
pictures. When the item is no longer available, use the visual to
show this. For example, show your child that there are no more
pictures of juice on the refrigerator after they have used them all.
Wait: Begin by presenting the symbol for “wait’ for a very brief
amount of time before your child can have a preferred item or
activity. It may help to pair the use of the “wait’ symbol with a
timer. Have your child trade the “wait” card for the item or activity.
For example, when your child asks for a snack, hand your child
the “wait” card, set the timer for 10 seconds, and then praise your
child’s waiting and trade the snack for the “wait” card.

First – Then Board
❏ What is it?
A First-Then Board is a visual display of something your child
prefers that will happen after completing a task that is less
preferred.
FIRST THEN
Eat lunch Playground
❏ When is it helpful?
A First-Then Board is helpful in teaching children with ASD to
follow directions and learn new skills. A First-Then Board
motivates them to do activities that they do not like and clarifies
when they can do what they like. A First-Then Board lays the
language foundation needed to complete multi-step directions
and activities and to use more complex visual systems.
❏ How do I teach it and use it?
Decide what task you want your child to complete first (what goes
in the “first” box) and the preferred item or activity (what goes in
the “then” box) that your child can have immediately after the
“first” task is done. This preferred item/activity should be
motivating enough to increase the likelihood that your child will
follow your direction.
Put the visuals on the board (e.g., photos, drawings, written
words) that represent the activity you identified. Present the board
to the child with a brief, verbal instruction. Try to use the least
amount of words possible. For example, before beginning the
“first” task, say, “First, put on shoes, then swing.” If needed, refer
to the board while your child is doing the task. For example, say
“One more shoe, then swing” when your child is almost done.
When the “first” task is completed, refer back to the board.
For example, say “All done putting on shoes, now swing!” and
immediately provide the preferred, reinforcing item or activity.
In order to teach children with ASD the value of the First-Then
Board, you must give them the reinforcing activity or item after
they complete the “first” task. Otherwise, your child may not trust
the board the next time you use it.
❏ What if challenging behaviors occur?
If challenging behaviors occur, continue by physically prompting
your child to complete the “first” task. Keep your focus on the task
rather than on the challenging behavior. Then it is important to still
provide the reinforcing item or activity, since the focus of the board
is on completing the “first” task, and not on addressing challenging
behaviors.
If you think challenging behaviors may happen, begin by intro-
ducing the First-Then Board for a task that your child usually
completes willingly and successfully. If challenging behaviors
become more difficult to control, it may be appropriate to
consider behavioral consultation with a professional to address
these behaviors directly.
Visual Schedule
❏ What is it?
A visual schedule is a visual representation of what is going to
happen throughout the day or within a task or activity.
❏ When is it helpful?
A visual schedule is helpful for breaking down a task that
has multiple steps to ensure the teaching and compliance of
those steps. It is also helpful in decreasing anxiety and rigidity
surrounding transitions by communicating when certain
activities will occur throughout the day or part of the day.
❏ How do I teach it and use it?
After your child understands the concept of sequencing activities
through the use of a First-Then Board, you can develop a more
complex schedule for a series of activities during the day.
Decide the activities that you will picture in the schedule. Choose
activities that really will happen in that particular order. Try to mix
in preferred activities with non-preferred ones.
Put on the schedule the visuals (e.g., photos, drawings, written
words) that show the activities that you have identified. The
schedule can be portable, for example, on a binder or clipboard,
or it can be fixed to a permanent place, like a refrigerator or wall.
Your child should be able to see the schedule before beginning
the first activity on the schedule. It should continue to be visible to
your child during the rest of the activities.
When it is time for an activity on the schedule to occur, cue your
child with a brief, verbal instruction. For example, say “Check the
schedule.” This helps your child pay attention as the next activity
begins. At first, you may need to physically guide your child to
check the schedule (e.g., gently guide by shoulders and prompt
your child to point to the next activity on the schedule). You can
gradually decrease physical prompts as your child begins to use
the schedule more independently.
When a task is completed, cue your child to check the schedule
again, using the procedure described above, and transition to the
next activity.
Bathroom Brush teeth Bath Get dressed
Provide praise and/or other positive reinforcement to your child
for following the schedule and for transitioning to and completing
activities on the schedule. It may be helpful to use a timer that
your child can hear to make transition times clear to your child.
Mix variability into the schedule by introducing a symbol that
represents an unknown activity (e.g., “oops” or “surprise activity”).
Begin to teach this concept by pairing this with a positive activity
or surprise. Gradually use this for unexpected changes in the
schedule.
❏ What if challenging behaviors occur?
If challenging behaviors occur, continue by physically
prompting your child to complete the task that is occurring.
Keep your focus on the task rather than on the challenging
behavior. Then transition to the next activity as communicated
by the schedule and still provide the reinforcing item or
activities indicated on the schedule, since the focus of the
schedule is on completing the tasks, and not on addressing
challenging behaviors.
If you think challenging behaviors may happen, begin by intro-
ducing the visual schedule during tasks that your child usually
completes willingly and successfully. If challenging behaviors
become more difficult to control, it may be appropriate to
consider behavioral consultation with a professional to address
these behaviors directly.
Visually Setting Parameters
❏ What is it?
Setting parameters involves using visuals to set clear boundaries
around items or activities and to communicate basic expected
behaviors, like waiting.
❏ When is it helpful?
Visually setting parameters is helpful in communicating limits that
are part of an activity and that may seem unclear to your child.
Some examples of situations where this might be useful follow.
Communicate physical boundaries of an area or activity, for exam-
ple, use a “stop” sign to mark where to stop in the backyard. Or
show how much of an item or activity is available before it is gone.
For example, place a “not available” picture on the computer
when it is not time to play on the computer. Or place pictures of 3
juice boxes on the refrigerator and remove or cover one each time
Breakfast Backpack Bus
juice is given. Show the need to wait for something that is delayed
but will be available soon, for example, by providing a “wait” card
paired with a timer.
x x
Ice cream Ice cream Ice cream
❏ How do I teach it and use it?
Begin to teach the use of these visuals in situations that have
clear, defined, brief parameters. As your child understands these
visuals better, gradually increase their use in more long-term
activities and with more abstract parameters.
❏ Examples:
Physical boundaries: Place the visual on physical boundaries
that already are defined (e.g., a door) and refer to it when the rule
is followed. For example, when your child stops at the door, point
to the stop sign and say, “Stop.” Give praise or reinforcement for
complying with this parameter. After you have taught the concept,
use the same visual during other activities or in other settings
where the same boundary is needed but is not as clear, such as a
“Stop” sign on the playground.
Limited availability: Decide the number of times or length of
time that the item or activity is available. Indicate that through the
visual, for example, 3 pictures of a juice box on the refrigerator to
indicate that 3 juice boxes are allowed that day. After the item or
activity has been used or done, show the change by using the
visual, for example, cross out or remove one of the juice box
pictures. When the item is no longer available, use the visual to
show this. For example, show your child that there are no more
pictures of juice on the refrigerator after they have used them all.
Wait: Begin by presenting the symbol for “wait’ for a very brief
amount of time before your child can have a preferred item or
activity. It may help to pair the use of the “wait’ symbol with a
timer. Have your child trade the “wait” card for the item or activity.
For example, when your child asks for a snack, hand your child
the “wait” card, set the timer for 10 seconds, and then praise your
child’s waiting and trade the snack for the “wait” card.
 As your child learns to use visuals for setting parameters,
gradually increase the length of time or the number of situations
in which your child is expected to wait for items or activities.
❏ What if challenging behaviors occur?
If you think that challenging behaviors may occur, introduce these
parameters during less difficult situations or begin with simple
expectations.
If problem behaviors occur, be consistent with the parameters
you have set. Focus on praising any aspects of the parameters
that are being followed, rather than shifting your focus to the
challenging behaviors.
Using visual supports can help you and your child with ASD
communicate and manage everyday activities in positive ways.
This publication was written by Whitney Loring, Psy.D., TRIAD
Postdoctoral Fellow, and Mary Hamilton, M.Ed., BCBA, TRIAD
Educational and Behavioral Consultant. This work was supported
through Beth Malow, M.D., M.S., Professor of Neurology, Principal
Investigator, Vanderbilt Autism Treatment Network Site, and Zachary
Warren, Ph.D., Assistant Professor of Pediatrics, Co-Principal
Investigator, Vanderbilt Autism Treatment Network Site. It was
edited, designed, and produced by the Dissemination and Graphics
staff of the Vanderbilt Kennedy Center for Excellence in Develop-
mental Disabilities. We are grateful for review and suggestions by
many, including by faculty of the Vanderbilt Kennedy Treatment and
Research Institute for Autism Spectrum Disorders (TRIAD) and by
the Autism Society of Middle Tennessee. This publication may be
distributed as is or, at no cost, may be individualized as an electronic
file for your production and dissemination, so that it includes your
organization and its most frequent referrals. For revision information,
please contact courtney.taylor@vanderbilt.edu, (615) 322-5658,
(866) 936-8852.
These materials are the product of on-going activities of the Autism
Speaks Autism Treatment Network, a funded program of Autism
Speaks. This publication was made possible, in part, by Grant no.
T73MC00050 from the Maternal and Child Health Bureau (MCHB),
Health Resources and Services Administration (HRSA), Department
of Health and Human Services (HHS). Its contents are solely the
responsibility of the authors and do not necessarily represent the
official views of the MCHB, HRSA, HHS. Printed March 2011.
Images ©2011 Jupiterimages Corporation.
Resources for Using Visual Supports:
❏ www.do2learn.com
❏ card.ufl.edu/content/visual.html
❏ www.kidaccess.com/index.html
❏ Eckenrode, L., Fennell, P., & Hearsey, K. (2004). Tasks Galore
for the Real World. Raleigh, NC: Tasks Galore.
Resources on Autism Spectrum Disorders:
❏ Treatment and Research Institute for Autism Spectrum
Disorders (TRIAD), Vanderbilt Kennedy Center, is dedicated to
improving assessment and treatment services for children with
autism spectrum disorders and their families, while advancing
knowledge and training. For information on TRIAD and Vanderbilt
autism services and resources:
Vanderbilt Autism Resource Line
Local (615) 322-7565
Toll free (1-877) ASD-VUMC [273-8862]
Email: autismresources@vanderbilt.edu
TRIAD Outreach and Training
(615) 936-1705
Web: triad.vanderbilt.edu
❏ Tennessee Disability Pathfinder, a free information and referral
service for all types of disabilities, all ages, provides information
on autism resources external to Vanderbilt. Local (615) 322-8529,
(1-800) 640-4636. Web: www.familypathfinder.org
❏ Local chapters of the Autism Society of America (ASA)
(www.autism-society.org) provide information, support, and
advocacy for individuals with ASD and their families.
Autism Society of Middle Tennessee
Phone: (615) 385-2077, (866) 508-4987
Email: asmt@tnautism.org
Web: www.tnautism.org
Autism Society of the Mid South
Phone: (901) 542-2767
Email: autismsocietymidsouth@yahoo.com
Web: www.autismsocietymidsouth.org
Autism Society of East Tennessee
Phone: (865) 247-5082
Email: asaetc@gmail.com
❏ Autism Speaks (www.autismspeaks.org/) provides resources and
support for individuals with ASD and their families.
Visual Supports and
Autism Spectrum Disorders
Introduction
FIRST
What are visual supports? A visual support Say “hi’
refers to using a picture or other visual item to
communicate with a child who has difficulty
understanding or using language. Visual supports
can be photographs, drawings, objects, written
words, or lists. Research has shown that visual
supports work well as a way to communicate.
Visual supports are used with children who have autism spectrum
disorders (ASD) for two main purposes. They help parents commu-
nicate better with their child, and they help their child communicate
better with others.
This brochure introduces parents, caregivers, and professionals
to visual supports and provides instruction on how to use them
effectively. Visual supports can be used with persons of any age,
although this brochure refers to children. Also, visual supports can
be used by caregivers other than parents.
Why are visual supports important? The main features of
ASD are challenges in interacting socially, using language, and
having limited interests or repetitive behaviors. Visual supports
help in all three areas.
First, children with ASD may not understand social cues as they
interact with others in daily activities. They may not grasp social
Get dressed Underwear Pants
Wait
THEN
Play with cars
expectations, like how to start a conversation, how to respond when
others make social approaches, or how to change behavior based
on unspoken social rules. Visual supports can help teach social
skills and help children with ASD use them on their own in social
situations.
Second, children with ASD often find it difficult to understand and
follow spoken instructions. They may not be able to express well what
they want or need. Visuals can help parents communicate what they
expect. This decreases frustration and may help decrease problem
behaviors that result from difficulty communicating. Visuals can
promote appropriate, positive ways to communicate.
Finally, some children with ASD are anxious or act out when their
routines change or they are in unfamiliar situations. Visuals can
help them understand what to expect and will happen next and also
reduce anxiety. Visuals can help them pay attention to important
details and help them cope with change.
Continued on next page
Shirt Socks Shoes